RFI Browser

RFI # 304:
CLP and NM1 no data reported

Submitter

Janice Cunningham

Description

A Medicaid FI is reporting CLP and NM1 segments without data reported in any data elements. This occurs when there is only a provider level adjustment to be reported.

Per the IG, CLP segment, data elements 01-04, 06 are required.
Per the IG, NM1 segment, data elements 01-02 are always required with other data elements being required based on the value reported in NM101.

The state has told my contact at ACS to not make any changes. ACS cannot make changes without approval from the state.

This is an example of these segments as they are being reported in the 835 4010A1.

I need verification from X12 group that this is non-compliant that I can provide to my contact.

Response

This issue is explicitly addressed in guide 004010X091 in section 3.1. Required is defined as "This item must be used to be compliant with this implementation guide." ASC X12 defines alphanumeric (AN) elements as containing at least 1 non-space character. ID type elements must contain a value from the defined code list. An 835 transaction that contains CLP and NM1 segments with required AN and/or ID elements with all spaces or empty values is not compliant with this guide.